Chapter 46: Assessment and Management of patients with Diabetes

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond?

"Ketones will tell us if your body is using other tissues for energy."

Health teaching for a patient with diabetes who is prescribed Human N, an intermediate NPH insulin, would include which of the following advice?

"You should take your insulin after breakfast and after dinner."

A client with diabetes mellitus has a blood glucose level of 40mg/dL. Which rapidly absorbed carbohydrate would be most effective?

1/2 cup fruit juice or regular soft drink

The nurse is administering lisper insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection?

10-15 minutes

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unity for every:

15 g of carbohydrates

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time?

3 months

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20-30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30am will reach peak effectiveness by:

8:30am

Insulin is secreted by which of the following types of cells?

Beta cells

Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-depenedent diabetes mellitus)?

Blood glucose can be controlled through diet and exercise

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?

Blood glucose level 1100 mg/dl

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker?

Dietitian

A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching?

How to control blood glucose through lifestyle modification with diet and exercise

A 60 year old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes?

Increased hunger

A 60-year old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes?

Increased hunger

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine?

Increases ability for glucose to get into the cell and lowers blood sugar

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes?

Insulin production insufficient

A young adult client with type 1 diabetes does not want to have to self-administer insulin injections several times a day. Which medication approach would the nurse recommend that best controls the condition and meets the client's needs?

Insulin pump

A nurse is teaching a client recovering from diabetic keto acidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response?

Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy.

A nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level should the nurse observe when assessing laboratory results?

Less than 70 mg/dL

Which type of insulin acts most quickly?

Lispro

A group of students are reviewing the various types of drugs that are used to treat diabetes mellitus. The students demonstrate understanding of the material when they identify which of the following as an example of alpha-glucosidase inhibitor?

Miglitol

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?

Nervousness, diaphoresis, and confusion

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?

Rapid, thready pulse

Lisper (humalog) is an example of which type of insulin?

Rapid-acting

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic keto acidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias?

Serum potassium level

A client with status asthmatics requires endotracheal intubation and mechanical ventilation. Twenty four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?

Sweating, tremors, and tachycardia

The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar:

The pancreatic hormone glucagon will stimulate the liver to release stored glucose.

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication?

The short-acting insulin is withdrawn before the intermediate-acting insulin

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8 F( 38.2 C). What effect do these findings have on his need for insulin?

They increase the need for insulin

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason?

Underlying problem of insulin resistance

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer?

Using sterile technique during the dressing change

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan?

When mixing insulin, the regular insulin is drawn up into the syringe first.

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise:

at least three times per week.

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check:

glycosylated hemoglobin level

A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client:

has type 2 diabetes

A patient who is diagnosed with type 1 diabetes would be expected to:

need exogenous insulin

A client with diabetic keto acidosis was admitted to the ICU 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 mL. Which physician order should the nurse question?

Change the second IV solution to dextrose 5% in water.

Which information should be included in the teaching plan for a client receiving glargine, which is "peak less" basal insulin?

Do not mix with other insulins.

A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings?

Finger

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?

Glucagon

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isoprene insulin suspension (NPH) to be taken before breakfast. At about 4:30pm, the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?

Serum glucose level of 52mg/dl

NPH is an example of which type of insulin

Intermediate-acting

NPH is an example of which type of insulin?

Intermediate-acting

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being primary action?

It enhances the transport of glucose across the cell membrane.

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order?

Reflects the amount of glucose stored in hemoglobin over past several months.

The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet?

Sensory neuropathy

Which of the following factors would a nurse identify as a most likely cause of diabetic keto acidosis (DKA) in a client with diabetes?

The client has eaten and has not taken or received insulin.

A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of:

hypoglycemia